Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you incorporate surveillance imaging for patients with ovarian cancer on maintenance therapy?
I typically follow the NCCN guidelines for monitoring/follow up: Visit every 3 months for 2 years, then every 3-6 months for 3 years, then yearly after year 5. CA125 (or other tumor markers) at each visit if initially elevated (with the understanding that CA125 monitoring does not affect survival, ...
How would you prescribe RT dose to post-op vulvar cancer with margins positive for severe dysplasia?
Need to quantify: If this positive dysplasia is dVIN, then I would favor re-excision, as it is high risk factor for local relapse and I don’t know if RT alone would be effective.
What is your approach to adjuvant therapy for a fully resected (contained morcellation and laparoscopic removal), isolated retroperitoneal leiomyosarcoma in a patient with a remote history of a hysterectomy?
I would stage the patient with scans and I would check the resected LMS for estrogen receptor. A fair proportion of uterine LMS are ER+ and I think that is more likely to be true for a late recurrence.If ER-negative, I would not give chemo with no disease to watch. Existing data from randomized clin...
What adjuvant treatment would you offer a young woman with stage IB uterine mullerian adenosarcoma with sarcomatous overgrowth?
Uterine adenosarcomas are rare tumors composed of benign endometrial epithelia with malignant stroma. An over growth of the sacromatous component is found in 10-50% of these neoplasms and tumors with this histologic finding clearly have a more aggressive biologic behavior. I would counsel patients t...
How do you select the concurrent cisplatin dose and schedule when treating locally advanced endometrial cancer with chemoradiation?
For locally advanced endometrial cancer treated with pre operative or definitive intent, we use weekly cisplatinum at 40mg/m2. Vargo et al., PMID 25218303
Can you omit the vulva from the radiation field in isolated LN recurrence several years after initial vulvectomy/nodal dissection without adjuvant RT?
In my opinion, yes, assuming the patient has had a recent well-done pelvic examination with close inspection of the vulva and vagina. A more difficult question, I think, is whether to treat the ipsilateral pelvic LN's. In general I would favor treating ipsilateral pelvic LN's to microscopic disease ...
Do you recommend probiotics to patients receiving pelvic radiotherapy?
I have not routinely recommended a probiotic to patients receiving abdominal or pelvic radiation but I did learn early on in my career to suggest it if they continued to have symptoms beyond the usual 2 weeks following radiation and found that it often helped a great deal. I have no idea which is th...
Is adenocarcinoma of the vulva more radioresistant than squamous cell carcinoma?
In general, SCC responds better to radiotherapy than adenocarcinoma, therefore I agree with @Dr. First Last that I would advocate for surgery (if possible) for these entities - however, given their location (close to introitus), often they will warrant adjuvant radiotherapy.
How do you approach ITCs in sentinel lymph node biopsy in a vulvar cancer patient?
If only SNLN bx is done, then based on GROINNS data, there is a 5% risk of additional node. Since nodal recurrences have a low salvage rate, I would treat with adjuvant RT.
What special considerations do you take when treating cancer patients with severe intellectual disabilities?
Caring for patients with any type of disability is both a privilege and a challenge. Severe intellectual disability poses additional challenges due to logistical, ethical, and moral dilemmas. Additional factors including patients' socioeconomic status, support system, language spoken to individuals ...